HEALTH SERVICES RESTRUCTURING COMMISSION
Ottawa-Carleton Health Services Restructuring Supplemental Report
January 1999
Ottawa-Carleton Health Services Restructuring Supplementary Report, January 1999
TABLE OF CONTENTS
I. II. BACKGROUND ............................................................................................................... 1 THE OTTAWA HOSPITAL PROPOSAL..................................................................... 2
TOH RATIONALE ..........................................................................................................................3 CHAMPLAIN DISTRICT HEALTH COUNCIL: REVIEW AND RECOMMENDATIONS .........................3 RESTRUCTURING COORDINATION TASK FORCE (RCTF): REVIEW AND RECOMMENDATIONS ...4 TOH RESPONSE TO ISSUES RAISED ..............................................................................................4
III.
SUMMARY OF HSRC DELIBERATIONS AND DECISIONS .................................. 4
ACCESSIBILITY ASSESSMENT .......................................................................................................6 QUALITY ASSESSMENT.................................................................................................................7 AFFORDABILITY ASSESSMENT .....................................................................................................8 ELIMINATION OF EXCESS CAPACITY ............................................................................................9 COMMUNITY AND MEDICAL STAFF SUPPORT ............................................................................10 SUPPORT BY ACADEMIC COMMUNITY .......................................................................................11 ACADEMIC MISSION ...................................................................................................................11 OTHER CONSIDERATIONS ...........................................................................................................11
IV.
CONCLUSION................................................................................................................ 12
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Ottawa-Carleton Health Services Restructuring Supplementary Report, January 1999
This is a supplemental report issued for the Ottawa-Carleton hospital and health care system by the Health Services Restructuring Commission (HSRC). It includes amendments to the HSRC‟s earlier directions for hospital restructuring in Ottawa-Carleton.1 This report should be read in conjunction with the first three Ottawa-Carleton Health Services Restructuring Reports (February 1997; August 1997; July 1998). The HSRC has amended its directions in response to a proposal from The Ottawa Hospital (TOH) developed during the process of implementing the Commission‟s directions, additional input received from the community, and further internal analysis. The lead commissioner involved in the review was George Lund; Maureen Law served as the associate commissioner
I.
Background
In its August 1997 and July 1998 reports, the HSRC issued directions for the Ottawa-Carleton Region. In those reports, the HSRC directed the amalgamation of the Ottawa General, the Ottawa Civic, and the Riverside Hospitals. The Salvation Army Grace Hospital - which had been issued a direction to close and transfer its programs to both the Ottawa Hospital and the Queensway-Carleton Hospital - was also invited to participate in the formation of the governance structure for the new Ottawa Hospital. On April 1, 1998 the three corporations merged and The Ottawa Hospital (TOH) was established. In its final directions, the Commission directed that the Riverside Hospital be decommissioned as an acute care hospital and that alternative uses for the site be explored. The board of TOH has been moving forward in implementing the restructuring plans laid out in the directions issued by the HSRC. One of the HSRC‟s key assumptions for achieving operating savings (based on the merger of the Civic, General and Riverside hospitals) was that upwards of 350,000 square feet of “excessive” and/or “redundant” space would be eliminated. The initial directions (1997) to TOH required that most of the space at the Carling/Civic site, and all of the space at the General/Alta Vista site, would be utilized, with excess capacity being eliminated through closure of the Riverside site as an acute care facility. The Ottawa Hospital approached the HSRC with a proposal that the Riverside facility (now belonging to TOH) be retained and used as an ambulatory site. This proposal would allow for the utilization of the newer Riverside facility and would result in the sale, transfer, closing, demolition or otherwise decommissioning of upwards of 350,000 square feet of older space at the Carling/Civic site. In the TOH proposal, the Riverside campus would effectively become a major ambulatory, diagnostic and clinical service center in support of the other two campuses (the General/Alta Vista and Carling/Civic sites), which would be devoted primarily to inpatient care. Expansion of
1
Health Services Restructuring Commission, Ottawa Health Services Restructuring Reports, February 1997, August 1997, July 1998.
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Ottawa-Carleton Health Services Restructuring Supplementary Report, January 1999
the General/Alta Vista campus would be significantly curtailed in the TOH proposal, and the excess capacity (in terms of the older building space) at the Carling/Civic decommissioned. After requesting clarification on a variety of issues, the HSRC has evaluated the TOH proposal using its standard methodology in a manner consistent with other siting reviews (i.e., an evaluation of the merits of the request based on the criteria of quality, accessibility, affordability, taking into consideration also the academic mission of the health sciences centre).
II.
The Ottawa Hospital Proposal
In August 1998, representatives of TOH met with the HSRC‟s chairman and senior staff to ask the Commission to consider an examination of the costs of utilizing the Riverside site as an ambulatory care centre, and decommissioning space at the Carling/Civic site. In September 1998, TOH submitted a Master Plan and Feasibility Study (“the plan”) to the HSRC outlining the details of its proposed plan. Subsequently, a number of additional documents were provided by TOH to the HSRC in response to issues raised. The plan addresses two key points. First, it provides additional information and clarification on a number of questions raised by the Commission.2 Second, it outlines the benefits of utilizing the Riverside site for establishment of a dedicated ambulatory care centre. The proposal noted that although ambulatory services would be provided at all three sites, the Riverside site would become the primary and dominant site for most ambulatory care activities. The Carling/Civic and General/Alta Vista sites would retain some ambulatory care services for emergency patients who require assessments and tests, and patient clinics for certain inpatient programs to improve clinical coherence.3 In total, more than 670,000 diagnostic imaging examinations and clinic visits are proposed for the Riverside site (61%), 205,000 for the Carling/Civic site (19%), and 210,000 for the General/Alta Vista site (20%).
2
The HSRC requested clarification of the following issues from TOH: the potential that the proposed model results in duplication of services that identification of excess plant capacity at the Carling/Civic campus that would not be decommissioned the variance in capital costs between the hospital's assessment and that of the HSRC's consultants the operating costs and savings of the three-campus model the clinical (i.e., medical staff) support for the three-site model and how coverage of multiple sites was being addressed how the academic teaching role of the University of Ottawa is addressed in the three-site-model. 3 These include three surgical clinics: neurosurgery (80% of visits at the inpatient sites), orthopaedics and plaster clinics (40% of visits at the inpatient sites); and, medical clinics including medical day care (50% of visits at the inpatient sites), haemodialysis (60% of visits at the inpatient sites) and endoscopy (25% of visits at the inpatient sites).
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Ottawa-Carleton Health Services Restructuring Supplementary Report, January 1999
TOH Rationale The Ottawa Hospital's Master Plan and Feasibility Study supported the use of the Riverside site largely because of its potential to utilize good physical space, reduce ambulatory congestion at other sites, and allow for development of a stronger focus on ambulatory care services. The evaluation criteria used in the analysis presented in the feasibility study were based on a combination of those used by the HSRC and those developed by TOH. The latter included: congruence with the vision, mission and core values of TOH reflection of the HSRC‟s directives of August 1997 and July 1998 promotion of quality of care affordability, cost-effectiveness, and the achievement of clinical efficiencies achievement of consensus support of education and research, and provision of French language services.
TOH‟s review clearly advocated the use of the Riverside site. The plan included details of the relative advantages of using this site to develop a state-of-the-art ambulatory care centre and focused primarily on issues related to: patient benefits, community, University and physician support, capital development, operating costs, and organizational change. TOH has also developed, and is ready to implement, a planning structure and process that will deliver on the commitments presented in the plan. Champlain District Health Council: Review and Recommendations The Champlain District Health Council (“DHC”) reviewed the plan and forwarded a submission to the HSRC explaining its reservations with it. The DHC is supportive of the movement of tertiary care services between the Carling/Civic and General/Alta Vista sites, and the rationalization of roles between the sites, as proposed by the HSRC. It urges extension of the deadline for the proposed closure of the Riverside site (i.e., beyond June 30, 1999) until the necessary modifications have been completed to TOH (Carling/Civic and General/Alta Vista sites) as well as the Queensway-Carleton Hospital so that there will be no deterioration in the quality of patient care, and to alleviate some of the pressure that health care providers are feeling. The DHC does not support the addition of a third site devoted specifically for ambulatory care. In December 1998, it provided the HSRC with an independent review4 of the plan. This review reinforced the DHC‟s recommendation that the HSRC not change its directions for a two-site hospital structure for the Ottawa Hospital. The DHC review resulted in a number of observations and recommendations about TOH‟s proposed plan. In particular, the DHC voiced concerns that operation of three sites would generate higher operating costs, increase problems related to adequate staffing, compromise
4
The review was conducted by the MHCG Limited on behalf of the Council.
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access to certain services by patients living in the western portion of the district, and lead to consequences for patients residing in outlying areas as well as physicians with community practices in these areas. The DHC also expressed concerns that the plan is inconsistent with the HSRC approach used in other communities. Restructuring Coordination Task Force (RCTF): Review and Recommendations The RCTF (“the Task Force”) wrote to the HSRC on November 18, 1998 to express its strong endorsement of the proposal. The Task Force believes that the TOH plan makes both clinical and economic sense. Although the Task Force believes that access to ambulatory care services will be improved in the three-site model, it supports the need for further detail on how the services will be allocated among the three sites to ensure clinical continuity of care and avoid duplication. The Task Force also acknowledged the potentially important role that a freestanding ambulatory care centre could play in shaping the future education and training for medical and other health professionals. TOH Response to Issues Raised The Ottawa Hospital responded to many of the questions and points of clarification posed by the DHC, the RCTF and the HSRC. The hospital, its physicians, staff, and board confirmed that they are in full support of: the amalgamation of the three hospitals and consolidation of most tertiary care services where it make good clinical sense (with the exception of the Ottawa Heart Institute) to the General/Alta Vista site of TOH the elimination of excess space [this will facilitate the realization of the hospital‟s (financial) recovery plan] the cost reduction through a decrease of overhead, the elimination of duplicate services, and the consolidation of purchasing, information systems and laboratory services, and the increase of operational efficiency through clinical and administrative benchmarking initiatives.
III.
Summary of HSRC Deliberations and Decisions
The HSRC‟s agreement to pursue analysis of TOH‟s proposal was premised on the understanding that the addition of a third site would lead to a reduction in excess capacity at the other facilities. In addition, the HSRC required reassurance of significant community support for the TOH proposal as the “local solution” including support of the staff. While there were specific questions raised about the content of the proposal and the process used in its development, the HSRC was convinced that there was sufficient local support to warrant consideration of the plan.
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In a manner consistent with its original assessment of the restructuring options for OttawaCarleton, the HSRC reviewed TOH‟s proposal against the criteria of access, quality, affordability and academic mission. The following analytical framework is normally used by the HSRC to evaluate the options and determine the one that “best” satisfies its criteria. It was applied to the three-site model: 1. Estimate total ambulatory requirements by assessing past utilization and potential growth, including the expected increases in day surgery and emergency services. 2. Review data regarding physical assessment of plants and sites (for current and future roles) including potential for upgrading and/or expansion and life cycle costs. Assess the potential to eliminate plants and sites where redevelopment potential is relatively low and projected life cycle costs are high, particularly where significant redevelopment is required just to maintain current activity. 3. Develop options for the configuration of hospital services taking into consideration facility capacity, optimal critical mass and clinical coherence for service delivery, and access indicators. 4. Assess the configuration options against the criteria of quality, access, affordability and „fit‟ with the academic mission. The HSRC‟s review of the proposal included a detailed comparison of the TOH plan with the two-site model directed by the HSRC. In reviewing the options, the HSRC also considered the following: Level of disruption to patients and service providers. Potential to build on existing programs or specialty strengths versus relocating a critical mass of clinical activity to enhance and develop smaller programs. Potential for optimizing existing capacity relative to populations served. Optimizing the use of high-quality facilities and functional sites. Reducing excess plant capacity.
As directed in the HSRC‟s August, 1997 directions, the Riverside site of the Ottawa Hospital should close as an acute care facility and be adapted for alternative uses. In its earlier deliberations on Ottawa-Carleton, the HSRC considered the possibility of using the facility for ambulatory care in conjunction with other hospital-based services, but rejected the concept because of the availability of suitable alternative facility space located at the General/Alta Vista site in close proximity to the Riverside. Use of the Riverside site solely as a stand-alone ambulatory care centre was not considered. The HSRC‟s review of the proposal has led to the following conclusions: Conversion of the Riverside facility into an ambulatory care centre (operating up to 16 hours per day) has merit and should be approved. However, further detailed planning must be carried out to address some of the issues raised by the HSRC and others in their
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review. In carrying out this work, the hospital should work with the district health council, its urban and rural hospital partners, and other stakeholders to address the impacts of the proposal on other services and facilities and to address the needs and requirements of rural health. The addition of an MRI unit at the Riverside site is not warranted and should not be approved. In the August 1997 report, the HSRC directed that the CT Scanner at the Riverside site be transferred to the Queensway-Carleton Hospital (QCH) to complete the services infrastructure at that facility. The planning for this transfer has progressed in the interim period and the HSRC maintains its original direction in this regard. The capital costs to implement the three-site model shall not exceed $75.3 million. The HSRC confirms the full estimate of operating savings, including those already achieved since 1995/96.
The rationale for accepting the locally-developed proposal is based on the following. Accessibility Assessment Consolidating the majority of elective and some urgent ambulatory care services at the Riverside site will lead to improved access to these services. In addition, the urgent care capability at the Riverside site will reduce the pressure on emergency services at the other Ottawa hospitals, thereby contributing to an overall improvement of access to these services. Some concern was expressed regarding the access to services by populations in the east and west ends of Ottawa-Carleton. These issues were considered in previous Ottawa reports. Utilization of the Riverside facility for ambulatory and urgent care services, instead of the General/Alta Vista or Carling/Civic campuses, will have little or no effect on the availability of these services for the populations of east and west Ottawa-Carleton. Enhancement of services at the Queensway-Carleton Hospital, and the availability of ambulatory services in the French language through L‟Hôpital Montfort in the near east end of the City, addresses the issue of proximity for some proportion of these populations. As the population grows beyond 2003, however, there may be the need to review further the ambulatory care requirements of these populations. Access to services in rural Ottawa-Carleton will depend on how outreach services are organized for the communities concerned. The provision of such primary, secondary and tertiary services by TOH (and the Queensway-Carleton Hospital and L‟Hôpital Montfort) throughout OttawaCarleton must be carefully planned in consultation with the DHC and those directly responsible for the provision of primary care in the rural parts of the district. Adoption of the three-site over the two-side model by the Ottawa Hospital is not germane to the development and implementation of such plans.
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Quality Assessment Critical Mass: The level of clinical activity envisaged by the HSRC for the Riverside campus is believed to be sufficient to ensure the efficiency and effectiveness of service delivery. In some areas, such as diagnostics, the HSRC has not accepted the service configuration as proposed by TOH as the provision of certain services at all three sites would pose a serious challenge to the maintenance of critical mass at all campuses. Clinical Coherence: There are a number of issues that require further planning and follow-up. The key observations/issues raised during the Commission‟s deliberations regarding the clinical coherence of the proposed services to be sited at the Riverside campus are as follows: The split of services between the sites must also be aligned to support the main missions of each site. The proposal suggests that 80 per cent of day surgery volume be allocated to the Riverside campus. In the Commission‟s opinion there has been insufficient consideration of what constitutes an appropriate balance between electively scheduled services and the surgical services provided at the inpatient sites. There may be unresolved issues with the planning of ambulatory services at the inpatient sites related to non-elective and non-scheduled services (i.e., emergency access). Quality issues respecting clinical relationships between inpatient and diagnostic imaging services and the related coverage issues (by specialist physicians in particular) require further consideration in the hospital‟s future planning. The addition of the third site will have operating cost implications but these will be marginal and are expected to be offset by lower operating costs at the Riverside site relative to the two inpatient sites. While the separation of elective and emergent diagnostic imaging services is expected to improve access to these services, significant duplication of diagnostic imaging services is proposed that has the potential to affect both coverage and efficiency of operations. The addition of further CT scanning services proposed in the model cannot be assessed by the HSRC in terms of projected patient need. The need for an additional MRI unit is not substantiated. Furthermore, the current MRI at the Carling/Civic site is significantly under-utilized given the type of technology currently in use. A higher intensity MRI for the Carling/Civic site (similar to the one at the General/Alta Vista site) would immediately increase the MRI capacity. It was also noted that 50 per cent of the capacity of the MRI at the Children‟s Hospital of Eastern Ontario (CHEO) remains unused and should be available for adult use in the Ottawa hospital system. Patient transfers between sites for related services is minimal in the proposal but related issues of clinical back-up, particularly for surgical services, are not fully addressed.
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The HSRC has concluded that: There is sufficient critical mass in terms of the number of ambulatory and urgent visits to the Ottawa Hospital to support creation of a stand-alone facility. The HSRC recommends that: TOH conduct further planning concerning the type and level of clinical service activity to be located at the Riverside ambulatory care site with special attention to the distribution of volumes among the three sites. In particular, the relative advantages of co-locating certain types of ambulatory care services with inpatient services must be explored further. The proposed additional MRI unit should not be approved. The introduction of an additional CT scanner in Ottawa-Carleton cannot be assessed by the HSRC until further justification is provided. Affordability Assessment Operating Costs: Based on the information available, the savings estimated by the Hospital exceed those estimated using the HSRC methodology for like comparisons. There is a net increase of $1.7 million related to plant operations between the two and three site models.5 The estimated operating savings associated with the two- or three-campus models can therefore be considered to be comparable. Other issues considered were: The time required for implementation of the three-site model allows for earlier realization of savings ($17 million more over the first two years). Prior to the merger, the cost structures of the two teaching hospitals were significantly higher than that of the Riverside Hospital. It is therefore expected that the use of the Riverside site for ambulatory care will facilitate the provision of lower cost services, despite their concurrent contributions to education and research, than exist currently at either of the two-inpatient sites.6 The HSRC supports the higher estimate of savings amounting to $70.1 million over 1995/96 levels of expenses that will be realized sooner with the development of the Riverside site as an ambulatory care centre.
5
The direct activity costs of ambulatory care in a stand-alone ambulatory care facility (as estimated by the HSRC methodology) is equal to that of locating this activity in the other two sites. It is important to note, however, that the HSRC method is not sufficiently sensitive to the differentiation of these costs, nor are the data relating to ambulatory care activity in hospitals detailed enough to support an analysis of relative costs of both options. 6 The hospital is estimating that more operating savings will be achieved in this model. In part, the Hospital is reflecting the lower cost structures associated with the Riverside operation compared to the two large inpatient campuses.
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Capital Costs: Given the relative age and condition of the capital plants and equipment at the three sites of TOH, the proposed use of the Riverside site is consistent with the HSRC‟s criteria of maximizing use of the best capital stock for patient care purposes. In capital cost terms, the HSRC estimates there to be an almost $3 million difference in HSRC estimates of capital costs between the two and three site models, in favor of using the Riverside facility as an ambulatory care centre. If other cost considerations, such as parking and municipal infrastructure are taken into account, matters which were not addressed in HSRC estimates, the cost difference between the two options is increased significantly.7 In both the two-site and three-site scenario, additional parking will be needed. However, the capital cost of building additional parking at the projected volumes estimated by the hospital would be approximately $8 million less on the Riverside site than would be required if the General/Alta Vista site were to be fully expanded (as in the two-side model). Furthermore, parking volumes may be reduced by the much easier transit access to the Riverside site. The HSRC heard from the hospital that an additional $30 million in municipal infrastructure costs (e.g., sewer, roads) would be required in the two-campus model. This is not a consideration by the HSRC in its assessment of affordability. The HSRC‟s revised capital estimates are $78.1 million for the two-campus model and $75.3 million for the three-campus model. It is estimated that the capital savings associated with utilizing the Riverside facility over the Carling/Civic facility will be approximately $3 million since many of the building's requirements are already in place at the Riverside facility. Furthermore, it is expected that the capital cost(s) may be even less if activity levels are adjusted at the Riverside campus to reflect further changes in the allocation of ambulatory care among the sites. Elimination of Excess Capacity During the HSRC‟s deliberations in 1997 (based on the information provided by the hospitals including detailed drawings) the Carling/Civic site had an excess capacity of over half a million square feet. In general, the capital stock of all Ottawa hospitals is relatively good. However, there are 22 buildings and wings at the Carling/Civic site, many of which date back to the 1920‟s or earlier, that are inappropriate for use as clinical space in a modern hospital or used for research or other non-clinical purposes. By contrast, much of the Riverside site was redeveloped in the late eighties and represents substantially better clinical space than much of that at the campus. The excess capacity identified in the August, 1997 report was limited to the Carling/Civic site.
7
The original capital estimate regarding the two-campus model did not take into account the additional costs related to two aspects not accounted for in the HSRC methodology: $17 million for parking at the General/Alta Vista site; and, the estimated $30 million in municipal infrastructure costs related to theAlta Vista site. Though there may also be additional parking costs related to use of the Riverside site as an ambulatory care facility , these costs are expected to be less than half those estimated by the hospital in the two-campus model.
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The HSRC consultant and TOH have identified a number of buildings at the Carling/Civic campus (see table below) that could be considered not available for alternative uses or decommissioned from further hospital use. The removal of excess capacity, where the plant and equipment cannot be used for clinical purposes, is expected to reduce further operating and capital renewal costs well into the future. It is important to note that the earlier information provided by the then Civic Hospital included tunnel space (132,755 square feet) in its calculation of clinical space. This space is not available for clinical uses. However, it is expected that connecting tunnels to older building (as noted below for decommissioning)will also be demolished and/or decommissioned. The following Table lists building space identified by TOH and the HSRC for decommissioning. Table 1: Space for Decommissioning
Item
Decommission of Veterans Building for Parking CPC – Parkdale Clinic Clinical Studies Building Laboratory Medicine Building Old Service Building Administration Building Main Building Diabetes & Lipids Metabolic Studies) Maintenance Building Total
Space (sq.ft.)
34,300 114,739 35,290 34,851 54,125 18,328 9,000 2,159 337,851
Therefore, the HSRC intends to direct the Ottawa Hospital to: Utilize the newer, higher-quality space at the Riverside location and close or otherwise decommission the equivalent or greater amount of space (upwards of 350,000 square feet) of identified excess capacity at the Carling/Civic campus. Community and Medical Staff Support The three-site proposal represents a locally generated solution that has received broad support from the community and support of the medical leadership at TOH. The Ottawa Hospital Transitional Medical Advisory Committee voted unanimously to support the plan. The Commission notes, however, that although there is sufficient critical mass (in terms of volume of visits) to support a stand-alone facility, the separation of medical clinics from the inpatient sites to an ambulatory care site may create coverage and convenience issues for the medical staff. These are issues that must be addressed as part of further detailed planning and implementation.
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Support By Academic Community There has been significant input of the academic community and of the Faculty of Medicine in the decision making process of TOH. The University of Ottawa has expressed its support for the three-campus arrangement noting its potential to change the focus of medical teaching and clinical research to the ambulatory environment, in keeping with the future orientation of many health care services currently delivered in inpatient facilities. According to the Faculty, ambulatory learning will be a key feature of the virage ambulatoire proposed in the threecampus model. The Riverside site offers opportunities for ambulatory education and research innovation in primary care and in secondary or consultation medicine. The development of the ambulatory care centre will also provide a novel environment for the undergraduate medical program. The University of Ottawa has also noted that a comprehensive ambulatory care center will serve as a vital functional laboratory for health services research and for the development of innovative new health care and health promotion programs.8 In particular, the Faculty of Medicine of the University of Ottawa has identified a number of specific research projects that would be linked to the „new‟ ambulatory care facility. Academic Mission The HSRC has encouraged the development of new models of medical education and research appropriate to the needs of the present and future health care system.9 The development of a stand-alone ambulatory care facility will, in the view of the HSRC, enhance opportunities for both teaching and research in an environment that will reflect more accurately the future direction of the majority of hospital care. In particular, the Faculties of Medicine and Health Sciences have an opportunity to develop an academic ambulatory care teaching model for undergraduates and postgraduates at the Riverside site that will embrace the training of medical students and other health professionals in an environment more akin to how the future will unfold in health services delivery. Other Considerations The HSRC has concluded that utilization of the Riverside site, and the subsequent decommissioning of space at the Carling/Civic site has the potential to offer a number of other benefits and opportunities for the hospital, its staff and the residents of the Ottawa-Carleton region:
8
The Department of Family Medicine and the School of Nursing at the University of Ottawa have received a grant from the Health Transitions Fund of the federal government to develop new collaborative care models involving medicine and the health sciences for the far north. 9 The considerations taken into account in assessing the impact of the three-site model on the academic mission included: critical mass (volume of cases), existing links with academic institutions, and the adequacy of resources for teaching and research.
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Decrease in the emergency caseload at other facilities through the provision of a broad range of urgent/prompt care services at the Riverside site. The integration of the medical and surgical staff of two previous teaching hospitals in a „neutral‟ setting will facilitate integration and help to overcome the history of competition and animosity that existed prior to hospital restructuring. The potential to achieve both capital and operating savings by utilizing the best available capital stock, and by using the historical lower case costs of the Riverside facility, to influence lower ongoing operating costs for the majority of ambulatory care services. The provision of the support of rural partnerships -- through the expansion of outreach services to the rural communities -- in diagnostic, therapeutic, medical and surgical services. The potential to foster innovation in areas such as, the Home Hospital Program, by facilitating development of outreach services and other primary care initiatives and alternatives to traditional means of delivering care.
IV.
Conclusion
In addressing the restructuring requirements in its August, 1997 report, the HSRC directed that The Ottawa Hospital be formed through an amalgamation of three existing hospitals: General, Civic and Riverside. Furthermore, the services of the amalgamated hospital, together with those transferred from the Grace and Montfort Hospitals, were to be rationalized on two sites: Carling/Civic and General/Alta Vista campuses. At the same time, the HSRC recognized that the capital stock represented by the Riverside could prove to be useful in roles other than a full service inpatient facility. While not specifying any particular role, the HSRC asked that TOH find an appropriate health care role for the Riverside Hospital. While the HSRC has some concerns regarding the level of planning to date and recommends further detailed consideration of a number of issues related to clinical coherence and critical mass, it is generally supportive of the development of the Riverside site as an ambulatory care centre subject to the following conditions:
1. Closure of the Riverside Hospital as an inpatient facility by March 31, 1999.
2. Reduction, through the decommissioning of a number of buildings of upwards of 350,000 square feet or more of space at the Carling/Civic site that will no longer be required for hospital services. 3. TOH will give further consideration to the allocation of ambulatory services among the three sites to ensure both critical mass in terms of volumes of various services and clinical coherence in terms of preserving and enhancing relationships between inpatient and ambulatory care services. 12
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4. TOH will work with the Champlain District Health Council, other hospitals, and its other hospital partners in Ottawa-Carleton and throughout the region during the next stages of planning to address and resolve concerns that have been raised. In particular, TOH will work with these partners to address the following issues: Detailed planning (involving the medical and other staff ) to determine a realistic range of services to be operated at this site. Further assessment of how the proposal will affect services at the other two campuses. Medical staff coverage for three sites to ensure that quality of care is maintained and enhanced.
5. TOH will be required to undertake the redevelopment of the Riverside ambulatory care centre along with the redevelopment of inpatient services at the Carling/Civic and General/Alta Vista sites for a total of $75.3 million in capital expenses (i.e., capital costs of restructuring related to all three sites will not exceed $75.3 million). 6. There will be further annual operating savings of $37.1 million (in addition to the $33 million saved to date through internal restructuring efforts) for a total of $70.1 million. These savings will be more than sufficient to offset existing deficit forecasts by the hospital. Furthermore, consolidation of administrative and support services between TOH and other Ottawa-Carleton hospitals, particularly the Children‟s Hospital of Eastern Ontario, which is part of the General/Alta Vista campus of TOH, should result in higher operating savings. 7. TOH will work with L‟Hôpital Montfort during the more detailed planning phase in establishing the ambulatory care centre at the Riverside site to ensure that the ambulatory care services in eastern Ottawa are planned in such a way as to facilitate the main missions of both hospitals. 8. The TOH will also work with the DHC and its district hospital partners during the detailed planning stages to address issues they have raised. 9. The additional MRI unit proposed for the Riverside campus will not be provided. 10. The University of Ottawa and other academic partners will dedicate their efforts to fulfilling the development of an exemplary ambulatory teaching and research programs associated with the ambulatory care centre. In conclusion, the HSRC supports the utilization of the Riverside site for use as an ambulatory care center as an alternative to further redevelopment of ambulatory services at both the General/Alta Vista and Carling/Civic sites of the Ottawa Hospital. Furthermore, the HSRC believes that the ambulatory care center offers the community a significant opportunity to restructure services for patients in a manner that will lead to improved access to services and support innovation in the future delivery of health care, health professional education, and research.
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